1/15. paracoccidioidomycosis and AIDS: report of the first two Colombian cases.The records of the first two Colombian patients with AIDS and paracoccidioidomycosis are presented. Both patients were males and had no known risk factors for hiv although in the past they had worked in the field where they could have been infected with the fungus. They exhibited the juvenile type of disease with multiple organ system involvement and symptoms of short duration. They were deeply immunodepressed as indicated by less than 100 CD4 T lymphocytes per mL; however, serologic tests revealed circulating anti-paracoccidioides brasiliensis antibodies and in one patient the first diagnostic clue came from such tests. In one case, the mycosis preceded the AIDS diagnosis while in the other, both pathologies were discovered simultaneously. Antimycotic therapy with itraconazole was administered for over 10 months, with an initial dose of 200 mg/day followed by 100 mg/day; marked improvement of the mycotic signs and symptoms was soon noticed an there have been no signs of relapse. The patients improvement was also due to the combined retroviral treatment that was instituted. In spite of the rarity of the AIDS-paracoccidioidomycosis association, physicians practicing in endemic areas should consider the presence of the mycosis in immunosuppressed patients, since a prompt diagnosis and institution of combined antimycotic-anti-retroviral treatments would result in patient improvement and survival. It appears possible that the longer survival time of today's AIDS patients would give the quiescent fungus the opportunity to revive, multiply and cause overt disease.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/15. central nervous system paracoccidioidomycosis. Report of a case successfully treated with itraconazol.paracoccidioidomycosis (PCM) is a primary pulmonary infection that often disseminates to other organs and systems. Involvement of the central nervous system (CNS) is rare and due to the fact that both clinical alertness and establishment of the diagnosis are delayed, the disease progresses causing serious problems. We report here a case of neuroparacoccidioidomycosis (NPCM), observed in a 55 year-old male, who consulted due to neurological symptoms (left hemiparesis, paresthesias, right palpebral ptosis, headache, vomiting and tonic clonic seizures) of a month duration. Upon physical examination, an ulcerated granulomatous lesion was observed in the abdomen. To confirm the diagnosis a stereotactic biopsy was taken; additionally, mycological tests from the ulcerated lesion and a bronchoalveolar lavage were performed. In the latter specimens, P. brasiliensis yeast cells were visualized and later on, the brain biopsy revealed the presence of the fungus. Treatment with itraconazole (ITZ) was initiated but clinical improvement was unremarkable; due to the fact that the patient was taking sodium valproate for seizure control, drug interactions were suspected and confirmed by absence of ITZ plasma levels. The latter medication was changed to clonazepam and after several weeks, clinical improvement began to be noticed and was accompanied by diminishing P. brasiliensis antigen and antibody titers. In the PCM endemic areas, CNS involvement should be considered more often and the efficacy of itraconazole therapy should also be taken into consideration.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
3/15. paracoccidioides brasiliensis in a postpartum Pap smear. A case report.BACKGROUND: There are several reported cases that describe female genital tract infections with opportunistic fungi, such as blastomyces dermatitidis, Coccidioides immitis, aspergillus flavus, cryptococcus neoformans and mucor. We describe a case of paracoccidiodomycosis limited to the uterine cervix. To the best of our knowledge, no such case has been described before in the English-language literature. CASE: A 27-year-old, healthy female, gravida 3, para 2, abortion 1, presented for a routine gynecologic examination at six weeks' postpartum. Her past medical history was unremarkable. A routine cervical/endocervical smear revealed the presence of multiple fungal forms at different stages of development with a characteristic "pilot's wheel" appearance consistent with paracoccidioides brasiliensis. Detailed medical examination of the patient did not reveal the presence of the primary infection in any other system. Cultures of the endometrium revealed no growth of the fungal organisms. The patient was asymptomatic, and therefore no therapy was initiated. Repeat Papanicolaou smears were negative for organisms. CONCLUSION: paracoccidioidomycosis can present as a limited form, involving the cervix only. Identification and recognition of the infection are important in cytopathology.- - - - - - - - - - ranking = 2keywords = organ (Clic here for more details about this article) |
4/15. paracoccidioidomycosis in organ transplant recipient: case report.paracoccidioidomycosis is a common disease in latin america but it is rare in organ transplant recipient patients. We report on a case of such mycosis in a renal transplant recipient. The patient presented with a large lung cavity on the left lower lobe, a rare radiological presentation of paracoccidioidomycosis. Unusual clinical and radiological manifestations of paracoccidioides brasiliensis infection can occur in immunocompromised patients.- - - - - - - - - - ranking = 5keywords = organ (Clic here for more details about this article) |
5/15. Simultaneous chronic pulmonary paracoccidiodomycosis and disseminated cryptococcosis in a non-hiv patient.An unusual case of chronic pulmonary paracoccidiodomycosis and disseminated cryptococcosis in a non-hiv infected patient is reported in a 72-year-old previously healthy man. A chest radiograph disclosed a bilateral diffused interstitial infiltrate involving middle and lower lung fields. Specimen samples taken from the tracheal tube revealed yeast-like organisms suggestive of cryptococcus neoformans and Paracoccidiodes brasiliensis. blood and cerebrospinal fluid culture was positive for C. neoformans and the immunodiffusion test against paracoccidiodin revealed a precipitation band. The patient died 24 days after the admission.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
6/15. Lymphoabdominal paracoccidioidomycosis simulating primary neoplasia of the biliary tract.The lymphoabdominal involvement in the sub-acute form of paracoccidioidomycosis shows a wide variety of clinical manifestations, ranging from fever and lymph node enlargement to infiltration of all abdominal organs, which can lead to a situation of abdominal surgical emergency. This case report presents paracoccidioidomycosis mimicking carcinoma of the biliary tract, The purpose of this paper is to call the general physician's attention for this important differential diagnosis of abdominal masses. Although paracoccidioidomycosis is rarely encountered in the united states and europe, it should be considered in patients who are suspected of having a fungal infection and have had previous exposure in an endemic area for this disease.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
7/15. paracoccidioidomycosis in patients with human immunodeficiency virus: review of 12 cases observed in an endemic region in brazil.OBJECTIVE: To study the clinical characteristics of 12 patients with paracoccidioidomycosis (PCM) and human immunodeficiency virus (hiv) infection. methods: The clinical manifestations, diagnosis, treatment, and outcome of PCM in 12 patients infected with hiv attended at a University Hospital of Mato Grosso do Sul, brazil, were evaluated. RESULTS: All patients were men, mean age 36.1 years old, and 11 had a diagnosis other than PCM as the aids-defining illness. lymph nodes were the organs most often involved (10 patients, 83.3%), followed by lung involvement, usually with an interstitial pattern (seven patients, 58.3%), papule-nodular skin lesions with central ulceration in six (50%) and ulcerated lesions of oral mucous membrane in five (41.6%) patients. Pleural involvement occurred in one patient who presented large pleural effusion beside a pathologic rib fracture caused by P. brasiliensis. Seven patients showed involvement in more than one extrapulmonary organ. In eight (66.6%) cases the diagnosis was established by direct microscopy of clinical specimens. All patients used trimethoprim-sulfamethoxazole and seven patients were also treated with amphotericin b. Eight patients died with progressive PCM manifestations. CONCLUSION: Our review demonstrates that PCM, an endemic systemic mycosis in brazil, when associated with AIDS, behaves clinically as an opportunistic disease.- - - - - - - - - - ranking = 2keywords = organ (Clic here for more details about this article) |
8/15. A case of imported paracoccidioidomycosis: an awkward infection in The netherlands.paracoccidioidomycosis is an important endemic mycosis in south america. In europe the disease is very rare and only found as infections in travelers to latin america. We report here the first case encountered in the netherlands for which the appropriate diagnosis was not attained for several months. A Dutch 60-year-old man presented with a painful ulceration in the buccal mandibular vestibular mucosa of three months duration. While his medical history was uneventful, he had worked, until 8 years prior to his presentation, as a carpenter for 25 years in the jungles of peru and ecuador. An aberrant chest radiograph, CT-scan of the lungs and increased erythrocyte sedimentation rate were suggestive of sarcoidosis or a bronchiolitis obliterans organizing pneumonia. There was no improvement in the patient's symptoms despite the use of budesonide and prednisone medication, as well as tuberculosis prophylaxis with isoniazide and rifampicin, and local use of miconazole. Quite to the contrary, as an irritated, irregular hyperemic mucosa and gingiva with ulceration were noticed during this period of time. These precipitated an incisional biopsy through which a mixed inflammatory cellular infiltrate and large yeast cells were found on histopathologic examination. Based on the patient's travel history and the multiple budding yeastlike cells revealed in the biopsy tissue, the diagnosis of paracoccidioidomycosis was finally made. This was supported by the isolation of paracoccidioides brasiliensis in culture. Antimycotic oral therapy with itraconazole was started and continued for 15 months. At two and five year follow-ups, the patient was asymptomatic. In europe, it may be expected that diseases that are endemic in other areas will be seen more frequently in countries where the diseases are not routinely encountered. It is most likely that the use of corticosteroid medication, with its inherent immunosuppressive effect, resulted in the reactivation of an infection acquired many years before in latin america. The etiologic agent then disseminated from the initial focal point to cause the ensuing oral mucous membrane lesions. The importance of the patient's prolonged residence in latin america was overlooked. The very long latency of endemic mycoses emphasizes the need for a meticulous history which should include not only recent trips, but also past residence in foreign countries.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
9/15. lobomycosis (keloidal blastomycosis): case reports and overview.lobomycosis is a deep fungal disease of the skin without involvement of internal organs or mucous membranes. The disease is characterized by skin nodules and plaques resembling keloid involving the earlobes, distal parts of the upper and lower extremities, and buttocks. In severe cases, large skin areas can be covered by disseminated or grouped and confluent nodules. Most cases are reported from South and central america. The fungus paracoccidioides (Glenosporella) loboi is abundant in lesions but is extremely difficult to culture. lobomycosis is resistant to chemotherapy, but in some cases it can successfully be treated by excision. Although the diagnosis is easily established by its typical clinical, histologic, and microbiological features, it is often misdiagnosed by physicians not familiar with the disease. We describe here five patients and present an overview of this rare disease.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
10/15. Functions of polymorphonuclear leukocytes and individuality of Jorge Lobo's disease: absence of the specific leukocyte digestive defect against paracoccidioides brasiliensis.Peripheral blood neutrophils (PMNs) from a patient with Jorge Lobo's disease (JLD) digested well phagocytosed paracoccidioides brasiliensis. We found no circulating antibodies against P. brasiliensis in the patient's serum. Such neutrophils showed myeloperoxidase activity and also digested normally phagocytosed candida albicans. We had previously reported the presence of a specific digestive deficiency of PMNs from patients with paracoccidioidomycosis (PARA) vis a vis P. brasiliensis. Current findings provide new information about leukocyte functions in JLD and bolster the view that JLD, PARA and their respective causative microorganisms are distinct.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
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